Book Review

Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development

N Engl J Med 2002; 347:150July 11, 2002

Article

Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development
By George E. Vaillant. 373 pp., illustrated. Boston, Little, Brown, 2002. $24.95. ISBN: 0-316-98936-3

An unavoidable task of the living is to change with time. Change is psychologically painful. Combined with the physical reality of stiff joints, facial wrinkles, and frustrating forgetfulness, aging is neither relished nor revered by our society. We empower ourselves with antioxidant vitamins, wrinkle-reduction surgery, and hair dye to prevent, reverse, disrupt, delay, or disguise the aging process. We prove our value by maintaining a ridiculously fast pace with an effervescent smile. We define our self-worth according to the many external modifiers that proclaim our youth. We are caught up in a fantasy that belies reality — every day, our mind and body grow older.

The first definition of the verb “age” provided by Merriam-Webster's Collegiate Dictionary, ninth edition, is “to become old: show the effects or the characteristics of increasing age.” The definition is nonjudgmental but is equally uninspiring. Whatever aging is, we do not need to welcome it. The second definition causes us to step back: to age is “to acquire a desirable quality by standing undisturbed for some time” or “to become mellow or mature.”

In his book Aging Well, George Vaillant takes this second definition of aging to a new level. Using a unique data base of standardized interviews exploring the psychological health of nearly 700 men beginning in 1939, he investigates whether important and potentially destructive situations in youth (e.g., disinterested or abusive parents or poverty) affect the psychological makeup of adults. Each participant was extensively reexamined at five-year intervals, allowing the assessment to evolve as individual development proceeded. The primary focus of the book is the characterization of healthy men and women in their 70s and older. The data on women are scant — there are only 40 follow-up interviews from an original cohort of 300 women — but this data base is better than most with regard to longitudinal research in women.

The book presents astonishing observations that do not always fit social myths. Unfortunate circumstances in youth do not doom a person to an unhappy adulthood: “What goes right in childhood predicts the future far better than what goes wrong.” Friendships with younger persons enhance the enjoyment of old age; these successful friendships are not so-called relationships in which the elderly are coddled by the young. Instead, the elderly give more than they take. A few observations add to the already overwhelming evidence that certain factors are associated with a healthy lifestyle. Cigarette smoking and alcohol abuse are more than bad habits; they destroy us. Exercise improves our ability to enjoy life.

The style of the book is enjoyable. Carefully chosen case histories (with names changed to protect confidentiality) are used to illustrate the technical points. The tendency toward simplicity is studiously avoided. Rigidity in thinking is not always maladaptive. Wisdom is multifaceted, and its definition changes with the circumstance. Successfully aging women do not take care of others but rather enrich the lives of other, younger people by sharing current experiences with them.

For nonscientific readers, Aging Well will provide the stimulus to reexamine their life and to determine whether they are doing everything possible to age well. The book will help readers systematically evaluate whether they have the infrastructure needed to age well. Aging Well may lead scientific readers down that bumpy road named “psychiatry.” They may feel threatened by the apparent judgments passed by the interviewers on the lifestyles of the participants. If so, such readers should read the appendixes first. These explain why and how the cohorts were established, who paid for this work, and what was expected from the results. There are vignettes of immature and mature defenses to an imaginary traumatic event, followed by rating scales that lead to scores, which in turn lead to the separation of participants into “happy–well” and “sad–sick” categories. After finishing these appendixes, readers will then appreciate Vaillant's humbleness and nonjudgmental approach. During the course of 30 years of work, Vaillant had to admit that the shape and scope of his own developmental concepts kept changing as the study progressed.

Although we all have anecdotal experience that aging can be fun, this book provides the only available longitudinal assessment of the factors that will permit us to age well. Aging well is giving to others. It is accepting our limitations with humor and dignity. It is cultivating the sparks of interest into our own eternal flame.

Margo A. Denke, M.D.
University of Texas Southwestern Medical Center, Dallas, TX 75390-9052